The Singular Triumph of Driving Down Peanut Allergies
· The Atlantic
In 2015, The New England Journal of Medicine published a major study showing that feeding babies peanut products significantly lowered their risk of developing peanut allergies. The findings contradicted advice that the American Academy of Pediatrics had issued previously, which said that peanuts, along with other nuts and fish, should not be introduced until children are at least 3. Based on the study—called the Learning Early About Peanut Allergy, or LEAP, trial—the AAP quickly revised its guidance.
Visit biznow.biz for more information.
Doctors had to scramble to adjust. David Hill, a pediatrician who was working in North Carolina at the time, told me that he went from room to room in his practice, rummaging through drawers to gather up all the handouts that instructed parents not to give their infants peanuts. “The information changed so dramatically,” he said, that he just threw the old pamphlets in the recycling bin.
Hill remembered getting “a lot of embrace and very little fear” from parents in response to the new instructions, which advised giving infants peanut products for the first time at as early as four months of age. People seemed happy that they no longer needed to monitor their young kids’ diets for peanut traces. “Absolving parents of this extra job of being the peanut police, it was greeted with a lot of relief,” he said. Anisha Patel, a pediatrician at Stanford University, told me that in her community, families similarly have seemed “totally receptive” to the idea of early peanut introduction. A pediatrician in Wisconsin, Dipesh Navsaria, told me, “I don’t think anyone has ever been surprised” by the new advice.
[Read: More American families are refusing vaccines]
The rollout of the new peanut regimen has not been perfect. One small study showed that some parents were unsure about the purpose of early peanut introduction—some thought it was to test whether the baby is allergic to peanuts—and therefore might not follow the recommendation. Not all pediatricians have adhered to the new guidance, because of a lack of awareness, disagreement with the guidelines, or time constraints during appointments—my son’s four-month visit was so hectic that my pediatrician didn’t mention anything about solid foods at all. Still, lots of parents all over the United States seem to have implemented the advice, with good results: A study published last year found that the rate of peanut allergies in American kids under 3 decreased by 43 percent in the period after the new recommendations were put in place. (The study did not prove that the drop in allergies was caused by the guidelines change, but “it’s a very, very tight association temporally,” a different David Hill, a pediatric allergist at the Children’s Hospital of Philadelphia and a co-author of the study, told me.)
The decline in peanut allergies is a public-health triumph that came after years of climbing rates. From 1997 to 2008, the rate of peanut allergies more than tripled. In 2008, an estimated 1.4 percent of children in the United States had them. Playgrounds, schools, and summer camps became peanut-free zones, and parents of children with allergies lived in fear that their child might accidentally eat something with peanuts in it. For much of that time, medical professionals around the world were at a loss regarding how to stem the allergy surge; some breastfeeding and even pregnant women were at times told to avoid peanuts. Now fewer families have to be cautious about how they feed their babies and toddlers, and more kids can enjoy a life without food restrictions or the fear of anaphylaxis.
The success of the peanut recommendation, though, is also a bit frustrating to health experts considering another scourge that’s plaguing the American pediatric world: Vaccination rates of school-age children are falling, and the incidences of some vaccine-preventable diseases are at the highest they’ve been in decades. Just because parents listened to pediatricians about peanuts, in other words, doesn’t mean they’re listening to the same doctors about vaccines. The reasons for the difference speak to how parents make decisions for their kids, how people evaluate threats, and how people decide what to believe—or not.
The physicians and allergists I spoke with gave me a few reasons some parents might be more receptive to the peanut advice than they have been to vaccines. First, although vaccines make up a small portion of pharmaceutical companies’ revenue, people may dislike that “somebody might be making money off” vaccines, Aaron Carroll, a pediatrician and the CEO of the health-services researchers’ membership organization AcademyHealth, told me. The profit motive may seem to taint the whole enterprise, as though the only reason a company might manufacture a vaccine, and a doctor would offer it, is to make a buck. Conversely, with food allergies, “other than Big Peanut,” Carroll said, “nobody’s making money.”
Parents may also see giving babies certain foods as a “natural” health intervention and getting their children vaccinated as an “unnatural” one. Jennifer Reich, a sociologist at the University of Colorado at Denver, found in a 2016 study that vaccine-hesitant parents tended to view their children’s bodies as “naturally perfect” and vaccines as “artificial” intrusions that are put into the body unnaturally, through injections. Some parents who participated in the study said they believed that the immunity a child gets from fighting off an illness was more natural than the protection a vaccination confers. (Indeed, a recent study conducted in Hong Kong found that parents were more likely to accept the flu shot for their children when it was framed as a natural booster for the immune system.) Alan Levinovitz, a religion professor at James Madison University and the author of Natural, told me that “naturalness” can represent empowerment—a sense that the parent is the one in charge of their child’s health. Anyone can buy peanut butter and stir a bit of it into their baby’s oatmeal. By contrast, he said, a doctor “tells you to take a vaccine; they have to administer it. They’re the ones in control.”
Additionally, vaccines seem to suffer from being too successful. Few people alive today recall a time when vaccine-preventable illnesses such as measles were truly rampant. “I think people don’t remember how sick or dead that virus could make you,” Paul Offit, a vaccine researcher and pediatrician at the Children’s Hospital of Philadelphia, told me. The dangers of food allergies, however, are very fresh in people’s minds. Anaphylaxis may feel scarier to parents right now than a measles complication such as subacute sclerosing panencephalitis, which leads to irreversible brain damage and death.
[Read: Another big difference between liberals and conservatives]
The story of the shifting guidance on peanut allergies could resonate with vaccine-hesitant parents in at least one way, however: The change shows that the scientific method works. The LEAP study came about after a group of researchers noticed that schoolchildren in the United Kingdom, where parents were advised to not give their babies peanut products, had higher rates of peanut allergies than schoolchildren in Israel, where many children were fed a peanut snack called Bamba early and often. For the LEAP trial, 640 infants were randomly assigned to either avoid all peanut products or eat them three or more times a week until age 5. The results showed that introducing peanuts early can cut the likelihood of allergies among infants at high risk for them by about 80 percent. That study and subsequent ones changed experts’ understanding of how allergies develop. Although some kids will have allergies no matter what, one way to lower the risk is to introduce allergen-containing foods through the gut when the child’s immune system is immature.
For all the skepticism that many people today have of mainstream medicine, this remains true: If researchers find that a particular recommendation is no longer valid, doctors can and will correct their guidance. “There’s always ongoing monitoring and making sure that we’re still on the right track,” Navsaria, the pediatrician in Wisconsin, said. If a vaccine ever turns out to be harmful or unsafe, most physicians will stop providing it. Science contains uncertainty—but careful doctors know when new information has clarified that uncertainty.